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SAN FRANCISCO -- Under Obamacare, most former foster youth will now remain eligible for Medicaid until age 26 – if they remain in the states they lived in when they aged out of care.

Advocates emphasize that because many former foster youth fail to access Medicaid once they’ve left the child welfare system, it is important to keep them continuously covered until age 26 without having to re-determine their eligibility.

It remains to be seen how states will make sure that former foster youth are aware of their eligibility and are able to enroll.

While about 6 million young adults currently have coverage under a parallel health care reform provision that allows them to stay on their parents’ employer-based plans, the provision for foster youth has not yet been implemented. Advocates are calling on states to prepare for the implementation of extended eligibility, and to create systems for enrolling former foster youth as they turn 21, and for informing youths up to age 26 of their eligibility.

“We should make sure that sustaining Medicaid coverage is in their transition plan,” says Tricia Brooks, a senior fellow at the Georgetown University Health Policy Institute’s Center for Children and Families (CCF).

Advocates from several states spoke at a teleconference this month hosted by CCF on the extended eligibility provision.

Qualifying for extended eligibility

There are over 400,000 children and youth in the foster care system, and almost all of them are enrolled in Medicaid. Brooke Lehmann, the founder of Childworks, an advocacy organization in Washington, D.C., says that 80 percent of foster youth have one or more chronic medical conditions that must continue to be treated after they age out of care.

“There’s simply a cliff where they were once provided for,” she says.

To qualify for the extended coverage, youths must have been in foster care at the time of their 18th birthday or have aged out of foster care based on their states’ age limits, and have been enrolled in Medicaid. Until now, states had an option (known as the Chafee Option), but not a mandate, to extend Medicaid coverage to former foster youths, and only until age 21. Only 33 states had adopted the Chafee Option. Now all states will be required to cover eligible youth through age 26.

But, under the extended eligibility provision, there is not currently a requirement that states must cover former foster youth who aged out of care in a different state. States simply have the option of doing so.

Brooks says that it will be important for supporters to “make the case” for a requirement that states must extend coverage to these youths. The Department of Health and Human Services could still change its interpretation of the provision and require states to do so. According to Lehmann, states are currently waiting for final regulations from the Centers for Medicare and Medicaid Services. Otherwise, in order to retain Medicaid coverage, youths will be forced to remain in whatever states they are living in when they age out of foster care. The drawback of that is it could limit educational and job opportunities for young people who are already more likely than their peers to experience homelessness and incarceration. And it appears discriminatory since there is no similar residency requirement for young adults who can stay on their parents’ employer-based plans.

States are in the process of determining how they will verify eligibility; verification will be of particular concern to states if they are to opt to cover youths from out of state. Advocates have suggested the creation of a registry by the federal government that would automate verification.

Preparing for implementation

Bridget Walsh, a senior policy analyst at the Schuyler Center for Analysis and Advocacy in Albany, says that she has seen “remarkable interest” from state agencies in New York with regard to the extended eligibility provision. Leigh Cobb, the Health Policy Director of Advocates for Children and Youth in Maryland, says that Maryland agencies have been similarly supportive, and that smooth implementation will rely on “as much outreach as possible, as early as possible.”

Both spoke of the importance of states’ preparations to track former foster youths between the ages of 21 and 26 so that they can be informed of their eligibility.

Children Now, an advocacy organization in California, recommends implementing the former foster youth provision on July 1 of this year, given that other youths in California are already benefiting from being allowed to remain on their parents’ plans.

The organization says that pre-enrollment would be ideal for youths who are turning 21 in 2013, so that they do not experience an interruption in their Medi-Cal coverage before being able to enroll under the new provision.

Children Now also advises that contact information must be gathered for these newly eligible youths so that they can be notified as soon as their states implement the extension of coverage. Outreach and education will be critical for not only the youths themselves, but also for foster parents, social workers and health care providers.

Overlooking the juvenile justice system

In addition to not securing the coverage of youth who want to leave their home states, the ACA also leaves out some former foster youth who age out when they are under the jurisdiction of the juvenile justice system.

When youth are solely under the jurisdiction of the juvenile justice system (as opposed to being under the dual jurisdiction of the foster care system and the juvenile justice system), their coverage under Medicaid can be suspended or terminated. If a youth ages out of foster care in juvenile justice while not being covered by Medicaid, he or she will not qualify for the extended eligibility provision.

It is not known how many foster youth are in the juvenile justice system. “There are no reliable national data on this,” says Mark Courtney, a professor at the University of Chicago School of Social Services Administration, who specializes in child welfare issues and foster youth.

Courtney points out, though, that many youth who might lose access to the coverage being extended for former foster youth could still qualify for Medicaid under income requirements.

This article is part of ongoing coverage by New America Media on the Affordable Care Act, supported by The Atlantic Philanthropies.

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